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3CE410199 Tank UNIFIED PROGRAM CONSOLIDATED FORA 1 U'NDERGROU'ND STORAGE TANK OPERATING PERMIT APPLICATION-TANK INFORMATION one form LIST) ILL TY'PF.OF ACTION (Clock one item only. Foran UST permaneld closure or rennsval,complete only this section and Sections 1,11,In,IV,and IN helovr) Jlu ❑ L NER:PERMIT ❑ 3.RENEWAL PERMIT O 5,CIfANGE OF INFORMATION G.TEMPORARY UST CLOSURE 7.UST PERMANENT CLOSURE ON SITE El R.UST REMOVAL DATE UST PERMANENTLY CLOSED: 4- a I DATE EXISTING LST DISCOVERED: DCN 1. FACILITY INFORMATION FACILITY ID N(Agrxn'Use Onh) _ 1 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) Costco Gasoline(Loc. No.38) HUSINLSSSITL ADURLSS ' CIIY "a 1616 E.Hammer Lane I Stockton 11.TANK DESCRIPTION LANK Ib# TANK VLAMIFiAC TC REI( +" TANK CONEICDR:cDON. rHI1TANR ©i.ASTAND-AI OVI TANK 1 �1 Containment Solutions ❑2.o\EINACUMPARINIENIEDTim r. (:nKln.ne P.µ.Iia aa4 nup.umxm in Ow nnil _.. _ __ DATE UST SYSTEM INSTATTED 435 TANK C P:AC'IT'Y IN GALLONS 4'" NL'NIHhR 1N'COMPARTMI'.NTS IN T'HI'UNIT March 2004 20,000 1 111.TANK USE AND CONTENTS TANK USE M la MOTOR VEHICLE FUELING ❑ Ih MARINA FL ki-ING ❑ Ic.AVIATION FUELING 4)9 ❑ 3.CHFMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE dnd,&n Usoa0111 ❑ 5.EMERGENCY GENERATOR FUEL[list 2:2,1.4,,1 ❑ &OTHER GENERATOR FUEL ❑ 95.UNKNOWN ❑ 99.OTHER 17INdINI: 4I°° CONTENTS PEIROLUUM: O la.KE(iULAR L NI PAULO ❑ le MIDGRADEUVCLAIIED ❑ Ih,PRLNH' 'UNLEADED Ito ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6..AVIATION GAS ❑ N.PETROLEUM HLFND FUFI- ❑ 9.01 HER PETRO[FUM f5 ecil 1: 4u°. NON-PFTROI FUNSD 7.USED OH. ❑ Ia.FTI TANOI 4 Lh 11.OTI IER NON-PETROLR-\I S ac[I is 1V. TANK CONSTRUCTION I N'PF.CW TANK ❑ 1,SING[ F N6AI 1 `.1R)URI F WAIT. 95.1 NKNO\VN In PRIMARYCON'TAINMENr 1.STFFt i,ETBERGLASS "".INTERNAL HLADDFR JII ❑ '.STILL I INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER ISpc:i Al: 444,, SI'.CONDARN'CONTAINMFNI' ❑ L Sllilll. IN 3.1981CRGIASS ❑ h.GX TFRIOR At1�NIHRANIi LINER ❑ is IA(KIi II U Nz ❑ 'M.NONE C3 95.UNKNOW11 90.OTHFRIS r'fs 1. uDa OVRNFII L PREVENTION • I,ALIUIBI F..&VISUAL A[ 2.HALL FIAAT ).F1L1.TURF SMUT-EFF VALA'F -`- ❑ 4.TANK NIEETSRE UIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT!WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION 1-SINGLE-WALLED N 2DOUBLE-WALLED Q 99.OTHER ♦lel SYSTEM TYPE LPRESSURE LER.\VIN i,CONVCNTIONAL SUCTION 4.SAFE SIR:TION :3 CeR$2061M]l ISN PRINIARY(ONFAINMFNT 1.STFFI 4.FiHFRfiI All N.FI EXIFJI F 10.RIGIU I'1..4STi(' 15, 11 90.NON[. 95.IINKNOWN 49.UJHI.RCS •cif'1: 4l`Ja SECONDARY CONTAINMENT ❑ I.STEEL ❑ 4.1'18FRGIL • N.FLEXIDLE ❑ 10RIGIDPLASTIC ,hib ❑ 90.NONE ❑ 95.UNKNOW'N ❑ 99.OTHER(SIX 2 fv): 46 4, PIPINGIURBINE('ONTAINMENI"SUMP'TYPE I.SINGLE WALL 4DOUBLE IYALL ❑ 90 NONE J6W VI.VENT,VAPOR RECOVERY(VR)AND RISER!FILL PIPE PIPING CONSTRUCTION VENT'PRIAIARY'C'GNLAINMENI" I.STEEL • 4,FIRERIiLASS IP RE(i1D PL AS i'H. U 90.NONE 0 '1901 HER ISincdyl 464e 4•LNTSECJWDAKYCONTAINMENI" ❑ I.S'ILLL (9 4.19RLROLASS 10IUUIDPLASII(' ❑ 9H.NONE 0 99.OI'HERISp',A) 444f .6411 VR PRRIARY('ONTAINMF.NT ❑ I.STEFI. [9 4.FIFFROLASN 10 RIGID PLASTIC- ❑ M.NONE 99.OTHER ISPNti fyl Ifdp IFI•[ VR SECONDARY CONTAINMENT I.STEEL M 4.FIDERGLAS.S Lj 10.RIGID PLASTIC El 90.NONE Lj 99.OTIIFRISp,,&v) 4"h 46 1tt VENT PIPING TRANSITION SUMP TYPE 1.SINGLE WALL 1DOUBLEWALL • 90.NONE 464i RISER PRIMARY('ON rAINMENT • LSTI:.LL 4.FIBERGLASS 10-RICH)PLASTIC 90.NONE 920THER ISPecifvl 441 6JL RISER SECONDARY CONTAINMENT 1.STEEL 3.FIDERGLAS.S 10.RICH)PLASTIC • 90.NONE 99.OTIIERISP"'fsl Is 41110 FILL COMPONENTS INS IALLFD 91 LSPILLBUCKET Ir 3.STRIKER PLAT F BOTTOM PROTFCFOR I@ TCONTAINMF.NTSUMP 411- VI I. °1"`VII.UNDER DISPENSER CONTAINMENT(UDC) 0)NN I III I'I ION I)'PF. 1.SING[F.UM ❑ -'.IR)1'At F WAI.1, ❑ LNOMSPFNSFRS ❑ 'uf.NONE CONNTRI's'TION MATERIAL ❑ I.STEEL 0 4.FIDERC.LASS ® IP.RIGID PLASTIC ❑ 99.OHIFRCS Ylfsl {hob- VIII. CORROSION PROTECTION Si'EEL COMI`ONENr PITCH EC1ION ❑ '.S:ACRIFICIAL 4NODIaSI 0 INIPRESSLOC'LAI I IN h ISOLATION IX. APPLICANTSIGN ATURE CERTIFICATION: I certiry that this I.ST 5y-stein(s compatible with the hazardous sJlhstance shred and that The information pro,ided herein is true.accurate, and is It'll coo [tante wish Ica a uircmrnts. ,I S16NAIURE APPLICANT NAME HoInH II APPLICANT ITLF. David H Lem Direct[,,of Real Estate Devefooment C PCF(IST-0- IR Hcs.(12/21107)